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DR. FAROKH MASTER PRESENTS
A CASE OF ABSCESS IN A DIABETIC PATIENT
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CASE OF A 41 YEAR OLD MALE
• Who came to us with an abscess on scrotum as well as on the perianal region
• He complained of burning pain over the area of infection.
• He has a past history of recurrent abscesses on scrotum for which he had taken several courses of antibiotics and had also undergone incision and drainage of the abscesses.
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• Patient is a known case of Diabetes Mellitus since the past 5-6 years and has been on anti-diabetic medication.
• Thus, the presence of Diabetes predisposes him to develop recurrent skin infections like abscesses and folliculitis.
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He also suffers from
Hypertension since 5-6 years
Hyperlidemia since 4-5 years.
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ASSOCIATED COMPLAINTS
• He suffers from recurrent episodes of acidity since 8-10 years.
• During such an episode he complains of: Burning sensation in the epigastric
region. Flatulence more during daytime. Flatulence increases after having tea.
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During such an episode he also
experiences : Pain on left side of chest which is better
after passing flatus or eructation.
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• He has a recurrent tendency to develop colds and cough.
• Colds are accompanied by nasal obstruction and sensation of congestion of nose.
• He also has itching of ear during an episode of cold.
• He has bad odor from mouth
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• He also has dental caries since many
years • Diagnosed as bifocal myopia around
15 years ago.
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• Another complaint that he suffers from is sleep apnea
• Around 3-4 a.m. , he suddenly wakes up from sleep with a sensation as if he is choked completely.
• As a result he feels sleepy the entire day.
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CURRENT MEDICATION
MEDICATION
TAB. GLUCONORM 1.5 mg
Anti diabetic drug
TAB. TELISTA 40 Telmisartan - Antihypertensive
TAB. STORVAS 5 Atorovastatin – Dyslipidemic agent
TAB. MONDESLOR Montelukast – Anti Allergic
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PAST HISTORY
2 Years ago : • Urticaria which was treated with
anti - histaminic
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FAMILY HISTORY RELATIVE ALIVE /
DEAD AGE DISEASE
FATHER ALIVE 81 YEARS D.M., RENAL CELL CA.
MOTHER DIED 75 YEARS D.M., HYPERTENSION
PATERNAL GRAND FA.
DIED 83 YEARS NO ILLNESSES
PATERNAL GRAND MO.
DIED 94 YEARS NO ILLNESSES
MATERNAL GRAND FA.
DIED 67 YEARS STROKE
MATERNAL GRAND MO.
DIED 75 YEARS CHRONIC KIDNEY DISEASE
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SIBLINGS
RELATIVE ALIVE/ DEAD
AGE DISEASE
SISTER ALIVE 49 YEARS HYPERTENSION D.M.
SISTER ALIVE 47 YEARS ANEMIA
BROTHER ALIVE 45 YEARS NO ILLNESSES
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HABITS
• He drinks 5-6 cups of tea daily. • Has liquor once a week.
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APPETITE AND THIRST
Appetite – Average.
• Hunger aggravates - He can’t tolerate hunger. When he remains hungry for long he gets irritable and restless. He also develops acidity.
Thirst • Drinks 3 liter water a day. • His mouth feels dry so he has to has to drink
water frequently.
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FOOD AND DRINKS LIKINGS IN FOOD : • Fried food • Rice • Spicy FOOD THAT DISAGREES WITH HIM : • He develops urticaria if he eats oranges and
meat.
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PERSPIRATION
• He perspires in axilla and groins.
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BOWEL AND BLADDER
• No complaints related to bowel and bladder
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THERMAL REACTION
• AMBITHERMAL
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SLEEP AND DREAMS
• His sleep tends to get disturbed
especially between 3-4 am due to sleep apnea and nose block.
• Sleep position : he prefers to sleep on the back.
• Snores during sleep
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MIND
ANGER: • He is very short tempered. • He was very aggressive earlier. But, over
the years he has become less aggressive. • He gets angry if things do not happen
his way.
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• He starts shouting on the people who
don’t work according to his expectations. • At times he also verbally abuses the
concerned person. • Clenches his teeth in anger.
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SENSITIVE TO CRITICISM • He is very sensitive to criticism and just
can’t take it. BROODING • He broods over the hurts people have
caused him. • He says, he does try to forgive them
however, the hurtful incidents keep coming in his mind again and again.
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MEMORY
• He is very absentminded. • Tends to forget where he had kept his
objects and then keeps looking for them.
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INTROVERT PERSONALITY : • He says he very much an introvert
person. BOREDOM : • He gets bored quite easily with things
and the tasks he is doing.
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LIFESPACE
• He was born in a metropolitan city. CHILDHOOD and SCHOOLING: • He was a very studious child. • Ambitious - He was also very ambitious. • He always wanted to be good at school.
Always strived to get good marks in exams.
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PARENTS : • Parents were extremely loving and caring. • Had good relations with siblings too. COLLEGE AND CAREER : • He took up science in junior college. • However, he didn’t get the expected marks
in 12th std. so, he couldn’t get into engineering which he wanted to. He felt quite disappointed.
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• So, he ended up pursuing Bachelors in Science followed by Masters in Business and Administration and found a job.
MARRIAGE : • He got married at the age of 34 yrs. • WIFE – wife is very caring and loving.
Always takes good care of the patient. • But, his parents had differences with her.
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• Although she would take good care of them as well, yet his parents weren’t very happy with her.
• This affected him as he had to create a balance between the 2 relationships. He had to try to keep his wife and his parents happy.
• He had to take care that he didn’t hurt the feelings of either of them.
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• His mother’s death affected him a lot. He felt he couldn’t do enough for her as a son.
• After that, He became extremely sensitive towards his father.
• He feels that he should do as much possible for his father as he can.
• His father is very old now and he wants to support him whatever ways he can.
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2002-2007: • He had a rough patch during this period. • His boss at the workplace wasn't
supportive at all. • He put the patient down always. • So, he couldn’t achieve the success in his
professional front although he was capable and deserving of it.
• This depressed him a lot.
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• He says, “Another issue that upsets me is about the dietary restrictions I have to follow very strictly.
• I used to be very obese and since I also have diabetes, I was put on a very strict diet to lose weight and to keep blood sugar level in control.
• I have lost a few kilos now.
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• But, since I am a foodie and love and enjoy good food, the restrictions kill me.
• I feel like I am trapped in a rat trap or in a maze and it’s a big struggle to try to get out of it.”
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RUBRICS
• MIND – ANGER – trifles; at • MIND – RESERVED • MIND – SENSITIVE – criticism; to • VISION – MYOPIA • NOSE – OBSTRUCTION – night • MOUTH – ODOR – offensive
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• TEETH – CARIES, decayed , hollow • STOMACH – HEARTBURN • ABDOMEN – PERSPIRATION –
Groins • MALE GENITAL/SEX – SCROTUM;
complaints of • CHEST – PERSPIRATION – Axillae • SLEEP – POSITION – back; on
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• GENERALS – COLD; TAKING A – tendency
• GENERALS – FAMILY HISTORY of – CANCER
• GENERALS – FOOD and DRINKS – fried food – desire
• GENERALS – OBESITY
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REMEDY Ammonium carbonicum
POTENCY 30 C
METHOD 5 Cup method
DOSAGE AND REPETITION
1 teaspoonful three times a day for 15 days.
HOMEOPATHIC MANAGEMENT (23 rd JULY 2012)
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FOLLOW UP 6th AUGUST 2012
• Patient felt much better in terms of the pain in the scrotal and perianal abscesses.
• Intensity of pain is much better. • That size of the abscesses have also
reduced to a great extent. • The other complaints like nasal blockage
and flatulence have also reduced.
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful three times a day For 15 days.
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• The size of both abscess has regressed a lot.
• Pain in the abscesses is around 80-85 % better.
• Nose obstruction is also better. • Flatulence is better.
FOLLOW UP 24th AUGUST 2012
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful three times a day For 15 days.
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• The scrotal and anal abscesses have healed completely.
• Flatulence and distension of abdomen is much better.
• Chronic nose obstruction is also much better.
FOLLOW UP 10th SEPT 2012
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful three times a day For 15 days.
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• No abscesses. • Acidity is much better. • Flatulence is better. • Eructation are better but still persist. • Gets fatigued easily. • Sleep is still disturbed. • Halitosis still persists.
FOLLOW UP 2nd OCTOBER 2012
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful three times a day For 30 days.
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• No Flatulence and acidity. • He doesn’t feel very fatigued now. • Halitosis is also better. • However, sleep is still not very sound. • Since 2 days he developed running nose
and a mild fever along with burning pain in eyes.
FOLLOW UP 18th OCTOBER 2012
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful four times a day For 30 days.
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• He had a recurrence of scrotal abscess.
• Lot of pain and tenderness of scrotum.
FOLLOW UP 9th NOVEMBER 2012
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TREATMENT
Ammonium Carb 30, 5 cup method, 1 teaspoonful every four hours for 2
days. Patient was advised to follow up after
2 days.
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• Pain in the abscess was slightly
better. • No regression in the size of abscess. • Flatulence increased since 2-3 days.
FOLLOW UP 11th NOVEMBER 2012
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful two times a day For 7 days.
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• Scrotal abscess is much better. • Pain is also much better. • Flatulence better.
FOLLOW UP 18th NOVEMBER 2012
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful two times a day For 21days.
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• No pain in the abscess. • Flatulence is much better. • Acidity much better.
FOLLOW UP 11th DECEMBER 2012
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PARAMETERS RESULTS
FASTING BLOOD SUGAR LEVEL
88 mg/dl
POST LUNCH BLOOD SUGAR LEVEL
90 mg/dl
GLYCOSYLAYTED HEMOGLOBIN
6 %
TOTAL CHOLESTEROL 93
HIGH DENSITY LIPOPROTEIN 29
INVESTIGATION
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PARAMETERS RESULT
LOW DENSITY LIPOPROTEIN
54
TRIGLYCERIDES 51
VERY LOW DENSITY LIPOPROTEIN
10
CHOLESTEROL/ HDL 3
S. URIC ACID 6.60
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful two times a day For 21days.
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• No abscess. • Flatulence is better • Acidity is much better • Sleep is still disturbed. • He wakes up at 3 a.m. and then is unable
to go back to sleep. • Nasal obstruction is better but persists
FOLLOW UP 17th JANUARY 2013
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful two times a day For 21days.
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• Patient feels much better than before. • He is able to sleep well now. • He feels more active and alert. • Flatulence and acidity is much better.
FOLLOW UP 11 FEBRUARY 2013
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful two times a day For 21days.
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• He suddenly developed and episode of
Coryza. • Watery nasal discharge. • Nose obstruction on both sides. • Feels drowsy.
FOLLOW UP 11 FEBRUARY 2013
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful thrice a day For 15days.
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• After the medicine was repeated frequently, Coryza settled in a few days.
• No nasal discharge and nose obstruction now.
• Feels active and energetic. • Flatulence is much better. • Acidity is also better. • Gets sound sleep.
FOLLOW UP 15th APRIL 2013
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful thrice a day For 15days.
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• He feels much better in all his
complaints. • Acidity and flatulence is better. • Sleep is much better.
FOLLOW UP 2nd MAY 2013
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PARAMETERS RESULTS
FASTING BLOOD SUGAR LEVEL
97 mg/dl
POST LUNCH BLOOD SUGAR LEVEL
120 mg/dl
GLYCOSYLAYTED HEMOGLOBIN
5.7 %
TOTAL CHOLESTEROL 121
HIGH DENSITY LIPOPROTEIN 36
INVESTIGATION
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PARAMETERS RESULT
LOW DENSITY LIPOPROTEIN
63
TRIGLYCERIDES 149
APOLIPOPROTEIN B 36
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TREATMENT
Ammonium Carb 200, 5 cup method, 1 teaspoonful thrice a day For 15days.